侧方入路关节松解术治疗外伤性掌指关节僵硬

目的 介绍手外伤后掌指关节伸直位僵硬的临床分型,以及侧方入路关节松解术的临床疗效.方法 根据术前、术中检查,对非骨性原因引起的掌指关节僵硬进行分型:Ⅰ型,单纯侧副韧带挛缩;Ⅱ型,侧副韧带挛缩合并伸肌腱、关节囊粘连;Ⅲ型,Ⅱ型基础上合并掌板粘连;Ⅳ型,Ⅲ型基础上合并背侧皮肤较大面积致密瘢痕粘连.对15例(54指)保守治疗无效的Ⅱ～Ⅳ型掌指关节僵硬者,采用侧方入路关节松解术,术后3d内以掌指关节屈曲80°～90°位石膏固定,之后改为最大屈指位支具固定,并逐步开始功能训练.结果 术后13例(46指)获得8～30个月的随访(平均21个月),2例(8指)失访.掌指关节主动活动度恢复至70～90°者5例,50°～69°者8例,除1例轻微疼痛及1例小指轻度尺偏外,未发现伸肌腱滑脱及关节不稳定和退行性改变.结论 对于外伤后具备手术指证的非骨性因素掌指关节伸直位僵硬,准确判断僵硬的分型及选择相应的术式,是充分恢复掌指关节活动度的关键所在,而术后系列康复训练是手术成功的必要条件.

Lateral approach arthrolysis to treat posttraunatic metacarpophalangeal joint stiffness

Objective To discuss the classification of posttraumatic metacarpophalangeal (MP) joint stiffness and the clinical outcomes of arthrolysis via a lateral approach.Methods Stiff MP joints with intact cartilage surface were classified based on pre- and intra-operative evaluations:type Ⅰ,simple collateral ligament contracture; type Ⅱ,collateral ligament contracture accompanied with adhesion of the extensor tendon and joint capsule; type Ⅲ,type [[ plus volar plate adhesion; type Ⅳ,type Ⅲ plus extensive skin scarring at the dorsum of the finger.According to the classification,arthrolysis was performed via a lateral approach in 15 cases (54 fingers) of type Ⅱ to Ⅳ MP joint stiffness.All the fingers were immobilized with a cast at 80° to 90° MP joint flexion for 3 days.Then,static maximum flexion splint was used with series rehabilitation procedures.Results Postoperatively 13 cases (46 fingers) were follow-up for 8 to 30 months (average 21 months).Two cases (8 fingers) were lost to follow-up.MP joint active range of motion recovered to 70° to 90° in 5 cases and 50° to 69°in 8 cases.Except mild pain in one case and mild little finger ulnar deviation in another case,there were no other complications.Condusion It is recommended that multiple procedures arthrolysis to release stiff MP joint according to pathological classification of posttraumatic MP joint stiffness is instructive in the selection of surgical treatment and key to the restoration of MP joint movement.Postoperative serial rehabilitation plays a critical role in the success of the surgery.